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  • South Africa's eHealth News will be watching

    Politics is too serious a matter to be left to the politicians, said Charles de Gaulle. South African’s now have help from eHealthNews to engage with hot topics affecting eHealth.

    The site had a busy April, with an in-depth look at major political parties’ views on the much debated National Health Insurance (NHI) plans. Contrasting views are presented in Political Parties in Favour of NHI and Western Cape Government Raises NHI Concerns.

    Today votes are being counted after South Africa’s 7 May general election as the country prepares for the 5th general assembly, 20 years into democracy. South Africans and eHealth News Africa will be watching carefully to see what happens with NHI and its massive implications for the country’s health, healthcare and eHealth. It’s good to know that the team at eHealth News will be watching too, and providing ongoing coverage of events, ideas and politics affecting eHealth in South Africa.

  • ENACTS helps to tackle malaria

    In March, ehna reported that climate change is increasing Malaria and asked Is Malaria on the march? Is it an eHealth priority? It was based on WHO’s The World Malaria Report 2012 FACT SHEET. It’s updated to the World Malaria Report 2013. Tanzania and Ethiopia have initiatives to start to deal with it by using climate data more effectively.

    The Thomson Reuters Foundation has a post describing the Enhancing National Climate Services (ENACTS) system established by the Tanzania Meteorological Agency in conjunction with the International Research Institute for Climate and Society (IRI) aims to identify malaria’s long-term drivers by compiling historical climate data for analysis by health policy-makers.

    The Ethiopia version of ENACTS is set out in ENACTS Ethiopia: Partnerships for Improving Climate Data Availability, Accessibility, and Utility. The authors, Tufa Dinku and Jessica Sharoff describe the project, a joint project with Ethiopia National Meteorological Agency, IRI and the University of Reading. It’s the first time that the IRI Data Library was installed and used outside of IRI.

    The project team found that collecting and processing 30 years of raw satellite data for Africa was demanding and took over a year. Now, other countries can adopt the methodologies and computer codes developed for generating the climate time series.

    ENACTS combines ground observations of rainfall and temperature to monitor changes. Tanzania is now applying the knowledge to help to tackle malaria. Augustine Kanemba, principal meteorologist at the Tanzania Meteorological Agency’s is reported saying that they faced difficulties using climate data in Tanzania to track health threats because there are now fewer weather stations that are now unevenly distributed. Satellite data overcomes this limitation.

    African countries’ health strategies can include ENACTS as an eHealth resource for investment. They may also need extra health workers to deal with the information as climate change contributes to an increase in malaria in new locations. It’s an excellent example of a shared and transferrable initiative across the continent.

  • How's progress on more electricity for healthcare?

    It’s not just that “riding a bicycle is about getting back to basics,” like Phil Keoghan, CBS’s Amazing Race presenter, suggests. Healthcare in Africa needs more important basics in place. Electricity is one of them. It’s now over a year since WHO’s report Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability was completed. It was published in Global Health Science and Practice over six months ago. Its survey of eleven countries in sub-Saharan Africa (SSA) found that:

    Only 34% of hospitals in SSA countries have reliable electricity supplies Energy access varies considerably In two countries, modest improvements in electricity access are underway Ambitious plans to improve health service delivery need to address this critical issue The United Nations Secretary-General’s Sustainable Energy for All (SE4All) initiative provides an opportunity to monitor energy access in healthcare facilities.

    Electricity limitations are a “silent barrier” for healthcare. Dealing with it needs several initiatives.

    A first step is establishing electricity access profiles of healthcare facilities. This can identify settings where lack of electricity may be a severe and underreported barrier to healthcare. Better data can inform innovations in the health and energy sectors and direct investments in areas with greatest need. This provides foundations for monitoring and managing progress inclosing energy gaps.

    Whilst the survey excluded off-grid energy used by some facilities, the gap it identified is still an enormous challenge. Since the report, have health and energy ministries integrated strategies for health, healthcare and eHealth to make the most of expanded electricity supplies? Overcoming the barriers is complex set of tasks that will take several years to complete. Using a bicycle isn’t one of them.

  • South Africa releases its health IOp framework

    Interoperability is a massive technical challenge for health and healthcare. South Africa has published its National Health Normative Standards Framework for Interoperability in eHealth (HNSF). It’s a superb document, now signed into law.

    It describes where the HNSF fits into the eHealth context, its scope, the philosophy behind it and how to select the best standards available. It sees four IOp levels

    Local paper-based patient medical records Local paper-based patient medical record system with some IT support Centralised electronic patient record system Fully integrated national shared electronic health record system.

    Achieving total IOp across health and healthcare is a massive task. Many countries are grappling with it, including the European project SemanticHealthNet project.

    The big IOp challenges are how to select enough, affordable IOp to meet current and short-term requirements and simultaneously lay down and expand the IOp foundations for the future. The issues are described in a recent review. The HSNF offers a constructive way into them.

    Affordability, capacity and capability are always challenges for health IOp, especially for a country trying to meet the health and healthcare needs of more than 50 million people. It reinforces the need for continuous, selective IOp implementation over a viable timescale.

    It’s also encouraging that the HSNF identifies the need to deal with security, privacy and data management. African countries lag well-behind high-income countries on eHealth regulation, and IOp creates extra regulatory challenges for privacy, confidentiality, data quality and security. Sixty-four regulatory aspects are described in a detailed regulatory model, which is maintained by African NGO tinTree. Numerous reports keep coming out of the USA on healthcare’s vulnerability to cyber-attacks. The lessons are clear and need learning and implementing.

    For other African countries, the HNSF provides an essential source of learning too.

  • Nigeria in the spotlight again

    Nigeria is in the spotlight again. This time it’s for its bold broadband strategy. Nigeria’s Minister of Communication Technology, Mrs. Omobola Johnson has announced the government’s plan to double investment in the ICT sector from $25 billion level to $50 billion in the coming years.

    She unveiled the ambitious plan during the official launch of the “Broadband Campaign” with the theme ‘Connected Nigeria, Connected Nigerians’.

    According to her, broadband penetration currently stands between 6-7%. The ministry is working with all relevant stakeholders to ensure that the National Broadband Plan 2013-2018 is successfully implemented. She went on to say that “to ensure that the Plan is monitored, we set up the Broadband Council in 2013 to ensure proper monitoring of the Broadband Plan implementation.”

    The ministry has been working with state governments and other stakeholders to tackle technical, financial and environmental obstacles to accelerated broadband roll-out across the country. As more citizens and patients use smartphones and iPads, the potential for eHealth links with each other and with health workers expand, creating new strategic shifts in health and healthcare.

  • Are African countries stuck with security?

    eHealth News Africa has frequently covered eHealth security issues. A common theme is, what can African countries do with their limited resources? HIE Watch, a Healthcare IT News blog, has set out some basic proposals.

    It says that encryption, done properly, and at a high level, is the most effective action an ICT department can do. Part of an encryption initiative is overcoming resistance, often derived from fear of change. A main concern is encryption’s inadvertent impact on usability and on integrated healthcare systems, especially where data shared horizontally between organizations. Licensing issues need dealing with too.

    Done properly, encryption should not cause disruption. It may slow performance, but it’s better than risking patients’ information. A modern complexity is the large number of operating systems in clinical settings that need encryption. Some of the devices have specific challenges. Encrypting and keeping track of these is high cost, so priorities are essential. Encryption is effective when protecting one or two rarely accessed fields, but this isn’t usually sufficient to protect healthcare data.

    So, for African countries, the key seems to be as much encryption as affordable. Deciding what to include and omit is an important decision.

  • Microsoft on the move

    After extended regulatory reviews, Microsoft completed its purchase of Nokia‘s mobile phone business, its Handset Division, on 25 April for about €5.4bn, $7.5bn. It’s the end of production of mobile phones for Nokia, which has come under commercial pressure from competitors like Samsung and Apple.

    The Financial Times (FT) reports that Microsoft will take on 25,000 Nokia staff, including former Nokia CEO Stephen Elop. He’ll be executive vice president of the Microsoft Devices Group, which includes Lumia smartphones and tablets, Nokia mobile phones, Xbox hardware, Microsoft Surface, and Perceptive Pixel (PPI) products. At the time of going to press, ehna couldn’t find a web page called www.microsoft.com/lumia. Nokia’s Lumia websites were still live. This could have changed by posting time.

    Lumia phones use Microsoft’s Windows 8 as their operating system, and has used other versions for various models. The FT says that Windows phone sales have been slow. Change may depend on the development path. An impact on mHealth remains unclear. ehna has already reported on Samsung’s ambitions for mHealth. It could be that the supply side expands with plenty of new opportunities.

  • Microsoft fixes Explorer for Windows XP

    It might be a complicated title for a web page, but Out-of-Band Release to Address Microsoft Security Advisory 2963983 is good news for Windows XP users. Microsoft says it’s issuing security update for Windows XP users and encouraging them to switch to a modern operating system, such as Windows 7 or 8.1 and upgrade to IE 11, the latest version of Internet Explorer (IE).

  • eHealth can benefit low-income patients

    Low-income patients have specific challenges, and eHealth is seen as part of the solution. A post on Health Affairs Blog says that low-income individuals with complex medical and social needs require bespoke solutions that meet their specific and unique circumstances. These patients often have multiple conditions and have unstable living conditions. Even though many lack permanent housing, are homeless or live in shelters, they own mobile phones. They text and use voice mail.

    Opportunities for eHealth to improve their care include:

    Providing consistent contact to communicate and monitor their conditions Co-ordinated care that avoids fragmented care from different providers Helping to manage and comply with complex medication regimens Digital tools designed track medication adherence could make this easier Proactively, managing health needs instead of reacting.

    Some of these, like medication support, are already in place in some countries, but are often small-scale initiatives. Adding other solutions can help to expand the impact. Remote tracking tools can help healthcare teams know and act promptly to new and changing clinical issues.

    The post is a reminder that African countries have many eHealth opportunities to improve healthcare for people in low-income communities. They benefit health workers too.

  • Big names at this year’s Mobile West Africa Conference

    Tomi Ahonen, is the man dubbed by Forbes as the world’s most influential mobile expert. He’ll be sharing his vision of the future of mobile at the Mobile West Africa 2014 conference in Lagos, Nigeria on 13-16 May.

    Dr. Ernest Ndukwe, considered one of the key figures in bringing about the mobile data revolution in Nigeria, will also be presenting his perspective at the conference. Speakers will be joined by the CEO and MD of Airtel Nigeria, the Founder of SPARK and iROKO Partners, and representatives from Nokia,DSTV Digital Media, Nigerian Breweries, PZ Cussons and Praekelt.

    Event founder Matthew Dawes commented “When we first debuted Mobile West Africa way back in February 2011 it was a different era. West Africa’s smartphone penetration was low, Nigeria’s first incubation space (CcHUB) was yet to be launched, the eCommerce boom was still years away, and mobile money was far from reality. It has been a remarkable few years and I would hope that in some way the event has contributed to that growth”.

    It truly has been a remarkable couple of years for mobile innovation. Hopefully, this trend will continue and fuel mHealth innovation too.

  • Is Kenya’s growth leading to middle-income status soon?

    Kenya is reaching an economic tipping point, and is passing through a period of sustained economic growth that will lift the country to the level of middle-income status of about US$1,000 per capita income by 2020 at growth rate of about 6% a year. This is the view in News & Broadcast, a World Bank web site.

    The Economist newspaper is a bit more optimistic. It is written on its blog that a revised way to estimate Gross Domestic Product (GDP) may show an increase in growth, however Kenyan officials don’t yet know the magnitude of the presumed new value. The base for calculating GDP was 2001, before the boom in telecoms and mobile money transfer market industry. The new GDP will use data from 2009 onwards and will now include growth in communications, banking and manufacturing.

    A small rise in GDP could see Kenya’s annual per capita income rise from US$943 to more than the World Bank’s benchmark for middle-income countries. A similar exercise conducted in Ghana in 2010 found the economy to be 60% bigger than what was previously recorded. The recent rebasing of Nigeria’s economy has pushed it to the lead in Africa.

    On a different communication forum, Ventures Africa reiterates that the Kenya National Bureau of Statistics (KNBS) has said that the rebasing, due for release in September, 2014 will increase the country’s GDP by 20%. The estimated GDP has gone up from US$41.6 billion in 2013 to US$50 billion. Per capita income is estimated to rise from U$943 to U$1,136, which is well beyond the World Bank’s benchmark of US$1,036 for middle-income countries.

    The question in our mind is, will the shift in GDP lead to more health care spending, hence more money for eHealth? Will global ICT health suppliers step up their interest in Kenya? These issues are for further debate.

  • Average global connectivity speeds on the rise

    Connectivity is a big challenge for African countries, so is there any progress? Akamai Technologies, a USA-based Internet firm, has released its Fourth Quarter, 2013 State of the Internet Report, based on data gathered from the Akamai Intelligent Platform™. The the report provides insight into key global figures such as network connectivity and connection speeds, attack traffic, broadband trends and availability.

    According to the report, the global average connection speed continued to improve in 2013, with a quarterly increase of 5.5%. Overall, 133 countries and regions ended the year with higher average connection speeds than the year before, contributing to an increase of 27%.

    By the end of 2013, a total of 83 qualifying countries and regions experienced year-over-year growth in their broadband adoption rates. This resulted in global broadband adoption growing 27% year-over-year in 2013.

    “We’ve reached a significant milestone in the improvement of average connection speeds,” said David Belson, editor of the State of the Internet Report. “The fact that all of the top 10 countries/regions’ average connection speeds are now at or exceeding the high broadband threshold – and continued strong growth in countries like South Korea and Ireland – is indicative of the progress that’s being made in broadband penetration. It’s reasonable to expect these promising trends will continue to be reflected in future reports.”

    In the fourth quarter of 2013, global Internet penetration was more than 780 million from 238 unique countries/regions. With global internet access steadily on the rise and connectivity speeds increasing annually eHealth services should become more reliable and effective.

    South Africa is in Akami’s league table of good performers, but its Internet adoption rate dropped 45% to 1.1%. It has the lowest average connection speed, 2.3 Mbps, of the big players. African countries have lots to do to catch up.

  • Predictive analytics takes another step

    As analytics expand in healthcare, it seems that Lao Tzu, 6th Century BC Chinese Poet’s aphorism that“Those who have knowledge, don’t predict. Those who predict, don’t have knowledge” might be running out of steam. A report in iHealthBeat says that Boston Children’s Hospital (BCH) is testing a new patient monitoring system that predicts changes in patients’ conditions before alarms notify health workers. The goal is to take some of the guesswork out of data from several monitoring systems.

    BCH is working with Etiometry, a Boston-based start-up specialising in healthcare analytics, to develop the Stability Index (SI), the predictive analytics model. Attending physicians in BCH’s cardiac intensive care unit are testing the Stability Index.

    The SI uses algorithms to analyse all of the data gathered from patient monitors, including heart rates, respiratory rates and other vital signs. Physicians can select the parameters they want to measure. SI then produces its risk assessment on a numerical scale. The most stable patients have a score of 0, the least stable score 4.

    Predictive analytics is an expanding activity. It needs a role in all African countries’ eHealth investment plans, even though it’s developing at a steady rate. As Oscar Wilde said “To expect the unexpected shows a thoroughly modern intellect.”

  • Wikipedia’s part of health’s Big Data

    The headline in PLOS Computational Biology is clear. “Wikipedia Usage Estimates Prevalence of Influenza-Like Illness in the United States in Near Real-Time.” Another big data initiative grabs headline coverage.

    A study by David J. McIver and John S. Brownstein from Boston Children’s Hospital, on the level of influenza-like illness (ILI) in the USA monitored the number of times people accessed specific influenza- or health-related Wikipedia articles each day between December 2007 and August 2013. They compared the data to official ILI activity levels provided by the Centers for Disease Control and Prevention (CDC). The National Institutes of Health and National Library of Medicine financed the study.

    The researchers’ Poisson model accurately estimated the ILI activity up to two weeks ahead of the CDC. The difference in the two sets of data was only 0.27% over 294 weeks. But, Wikipedia-derived ILI models performed well for events with high media coverage, such as the 2009 H1N1 pandemic, and unusually severe flu seasons, such as in 2012–2013.

    Google’s been estimating flu too. Wikipedia accurately estimated the week of peak ILI activity 17% more often than Google Flu Trends. It was also more accurate than Google in measuring ILI intensity. Google Flu Trends’ methodology provides global data.

    Study’s like these point to the considerable potential of Big Data for African countries. They provide the evidence for an extra dimension for their eHealth strategies and a new line in eHealth investment plans.

  • EHRs create extra jobs

    Scribes have been part of society and learning for eons. Wayne Gerard Trotman said “May the scribes record it,” acknowledging their role in his book Veterans of the Psychic Wars. Now, doctors in the USA are employing them to help with EHRs.iHealthBeat has a report that specialist employment agencies are showing growth in demand of up to 50% for medical scribes. It summarises a blog on Shots, a National Public Radio (NPR) site.

    Dr Devesh Ramnath, an orthopaedic surgeon in Dallas, recently switched to EHRs. He found he was“Focused on just trying to get the information in, and not really focusing on the patient anymore.” He was also spending two to three hours every clinic on his EHRs. His solution was to employ a medical scribe. Now, Dr Ramnath examines patients and his scribe sits quietly in the corner, typing notes and speaking into a handheld microphone to compile records for review.

    It may be that EHRs’ potential time saving benefits have taken a hit. They now need rigorous scrutiny as part of the business case. “May it be written. May it be done” isn’t just for psychic wars.

  • Is Nigeria Africa’s new top student?

    Since the announcement that Nigeria is now the wealthiest country in Africa with a GDP of $509 billion, the country has received global attention. First Oracle announced its commitment to the country. Now Microsoft has re-emphasized its commitment to the continent and more specifically Nigeria.

    “We have invested heavily in ensuring that we have a good impact on the local economy. This includes job creation, support for the youth in Nigeria, software donations to NGOs and the development of local innovation,” said Microsoft Nigeria’s General Manager, Kabelo Makwane.

    Commenting on Microsoft’s strategy for Africa, Makwane said, they are looking to shape the next 20 years on the continent through the Microsoft 4Afrika Initiative. It was launched a year ago and has three pillars: 21st century world-class skills, providing affordable access and fostering local innovation.

    While being the most popular kid on the school ground is always fun, what will the real life benefits be? Will the standard of living increase for Nigeria’s population? Will the growing economy help support and develop a more efficient healthcare system? Microsoft 4Africa Initiative strives to foster local innovations, so let’s hope that it includes the development of eHealth services.

  • Cyber-security keeps worrying USA and business, so healthcare

    Cyber-security seems to be a worry becoming an obsession. Most companies, including healthcare organizations, see cyber-crime as bigger than other big business risks, say the findings of a survey by thePonemon Institute a research centre based in Michigan and dedicated to privacy, data protection and information security.  Some 94% of the 80 healthcare organizations in the survey said they were aware of one data breach or more over the last two years. The estimated cost was $6.78 billion a year. Ponemon’s findings include:

    Protecting against the financial cost of cyber-risks ranks as high as, or higher than other insurable risks Responsibility for managing cyber-risk is moving outside the ICT team, with risk management or compliance officers taking it on Most companies either have cyber security insurance or are considering it About 30% of companies are not currently interested in insurance.

    Healthcare and pharmaceuticals were the survey’s third-largest industry group. FierceHealthIT reports that privacy experts speaking at the Healthcare Privacy Summit earlier this summer said healthcare organizations are too reactive towards health data security. Since then, asurvey of the cyber-security workforce by Semper Secure, a public-private partnership, found that healthcare is fourth-largest employer of cyber-professionals after government, manufacturing and defence with aerospace. This may indicate a shift in emphasis. This sounds encouraging, but according to The Economist, just more cyber-professionals are not enough. They need a change in their approach. Many executive’s believe that data inside their firewalls are safe, what is outside is not. Business must drop this binary view. Cyber-criminals are beaching firewalls with minimal effort, so stronger and smarter defences are needed too. eHealth News Africa has covered security issues in several posts: Medical devices may not be secure enough, Cyber-crime worries for Cote d’Ivoire, Ghana’s cyber security strategy with ITU underway and Most health data breaches are cyber-crimes.

  • Microsoft’s IE has a bug

    If you’re using one of Microsoft’s Internet Explorer (IE) versions 6 to 11, you could be exposed to cyber-threats. The BBC has reported that Microsoft has warned users that these IE versions are vulnerable and hackers could gain access and user rights to their computers. There have already been limited, targeted attacks. Microsoft says it is eradicating the weakness. Users logged on with administrative user rights may enable an attacker who has successfully exploited the vulnerability to take complete control of an affected system.

    NetMarket Share, Internet statistics specialists, says the IE versions affected have more than 50% of the global browser market. This is a huge potential impact.

    Users should have received a security advisory notice. Actions“may include providing a solution through our monthly security update release process, or an out-of-cycle security update, depending on customer needs”. People still using XP won’t receive these updates because Microsoft ended official support earlier this month. Estimates are that about 30% of all desktops are still running Windows XP.

    IE on Windows Server 2003, Windows Server 2008, Windows Server 2008 R2, Windows Server 2012, and Windows Server 2012 R2 runs in a restricted mode, on Windows Server 2003, Windows Server 2008, Windows Server 2008 R2, Windows Server 2012, and Windows Server 2012 R2 runs in a Restricted Enhanced Configuration. It “mitigates this vulnerability.”

  • mHealth has a clear business case, says Vodacom

    Return on investment (ROI) is an economist’s way of saying, “why bother?” For eHealth, a socio-economic return (SER) is a way of including all stakeholders. Mojca Cargo of Groupe Speciale Mobile Association (GSMA) has found a reason for eHealth investment. Her report of the Vodacom’s Kirsten Miller-Duys’ presentation, “The role and value of mobile operators in mHealth” at an event in Johannesburg, South Africa, shows a way ahead. Vodacom’s view is that the business model depends on where mobile operators place themselves in five locations along the ICT value chain, from lowest to highest value:

    Communication system: one direction content pushInformation system: bi-directional information flowManagement system: support information design and auditDecision support system: assist clinical and admin decision-makingExpert system: intelligent cross-platform partnerships.

    The higher up the ICT value chain operators go, the more progression mHealth enables. Four reasons to be involved in mHealth are to:

    Diversify revenue streamsLeverage capabilitiesEnhance competitive differentiationImprove health outcomes.

    The Pan-African mHealth Initiative supports GMSA’s goals. One of objective is to demonstrate the business case for long-term investment in mHealth linked to sustainable partnership and collaboration opportunities for mobile and health stakeholders. There seems no shortage of enthusiasm. GSMA’s research in 2012 found that globally, 794 mobile operators had mHealth initiatives, and that 269 mHealth products and services were led by mobile operators. eHealth News Africa has identified an increasing change in emphasis from SMS-based mHealth towards clinical applications. When coupled with the changing role of community health workers, it strengthens the business case for mHealth in Africa.

  • Africa – a growing eLearning market

    By some estimates eLearning is already a $56 billion global industry, set to double by 2015. The US and European markets account for nearly 70%, with Asia-Pacific further contributing to the aggressive global growth.

    In Africa, a growing number of companies and industries are taking up eLearning for its success rate and its low cost of delivery. eLearning has rapidly evolved, and can do so much more than just maximize a company’s training impact. Retailers, financial services providers, mining groups and fuel companies are all taking advantage of eLearning with applications ranging from “sales and customer service training to induction courses, professional board exams, and even flight and surgical procedures training”.

    eLearning in healthcare is rapidly expanding and includes a range of initiatives and projects. From new devises such as Google glass, to nurse teaching programs in Kenya. The possibilities seem endless. Healthcare should grab hold of this opportunity to fully realize the potential of eLearning.